Basic and translational aging research in China: present and future

Impact of medical-nursing combined policy pilot on hospitalization frequency of middle-aged and older patients with chronic diseases: a quasi-experimental study based on China Health and Retirement Longitudinal Study

Background

To address the growing burden of older adult care, the Chinese government has introduced a policy that integrates medical care with elder care, launching two batches of national pilot projects. A majority of the older adult population suffers from one or more chronic diseases, with many experiencing multiple chronic conditions, necessitating support from both elder care and medical services.

Methods

Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, this study employs the difference-in-difference (DID) model to analyze the impact of the integrated medical-nursing policy on the physical health of older patients with chronic diseases.

Results

The study found that the average annual number of hospitalizations for older individuals with one or more chronic diseases was 0.276. The integrated medical-nursing policy reduced hospitalizations by 0.0405. Additionally, the average annual hospitalization rate for older individuals with two or more chronic diseases was 0.339, higher than the former group. The integrated medical-nursing policy reduced hospitalizations by 0.0738 in this group.

Conclusion

The pilot study demonstrates that the implementation of the integrated medical-nursing policy has significantly improved the physical health of older patients with chronic diseases. The government should promote these policies on a larger scale, explore various forms of integrated medical care, and provide more comprehensive medical and elder care services for older patients with chronic diseases.

Risk factors of falls in rural elderly of Ningxia in China: a prospective cohort study

OBJECTIVES

To identify risk factors associated with falls in older people in rural China.

METHODS

A prospective cohort study was conducted across 27 villages in the rural areas of Ningxia, China. After excluding individuals younger than 60 years, a total of 758 out of the initial 822 participants were ultimately included for the collection of baseline information. Participants were followed up through telephone calls or face-to-face interviews at 3rd, 6th and 12th months following the baseline investigation. The Cox proportional hazards regression model was used to examine risk factors of falls.

RESULTS

A total of 758 participants underwent baseline information surveys, and all samples were included in the Cox model analysis. The study found that being woman (RR=1.879, 95% CI: 1.313 to 2.668), smoking (RR=1.972, 95% CI: 1.238 to 3.143), use of painkillers (RR=1.700, 95% CI: 1.226 to 2.356) and higher systolic blood pressure (SBP) (RR=1.081, 95% CI: 1.013 to 1.154) were associated with higher risk of falls among the elderly in rural China. After excluding those who were lost to follow-up or deceased, 738 participants completed the follow-up. There were 341 men (46.2%) and 397 women (53.8%), with an average age of 66.8±5.0 years. The fall rate in study area was 23.8% during the follow-up period.

CONCLUSIONS

The fall rate among the elderly in rural China was higher than other areas. Our findings revealed that being woman, smoking, medication usage, elevated SBP and people with a higher body mass index were risk factors for developing falls.

Time trends in the incidence of interstitial lung disease across Brazil, Russia, India, China and South Africa (BRICS) from 1990 to 2019: An age-period-cohort analysis

BACKGROUND AND OBJECTIVE

The global incidence of interstitial lung disease (ILD) has risen over the past few decades. However, few studies have evaluated the status and incidence trends of ILD in Brazil, Russia, India, China and South Africa (BRICS). This study assesses the trends of ILD incidence across the BRICS with an emphasis on ILD changes from 1990 to 2019.

METHODS

Incidence rates were estimated by the data obtained from the Global Burden of Disease Study 2019 (GBD 2019). Age-period-cohort modelling was used to estimate the effects on ILD from 1990 to 2019, and the net drift and local drift were calculated.

RESULTS

In 2019, a total of 11.4 million cases of ILD were reported in the BRICS countries. From 1990 to 2019, the incidence rate of ILD in BRICS showed an upward trend. India consistently reported the highest incidence rate, while China showed the fastest growth rate (107.6%). Russia reported a similar incidence rates for men and women, with a lower age of peak incidence compared to the other four countries. We found the time effect was unfavourable for BRICS in the first decade, especially for Brazil; in China and Brazil, the risk of people born after 1960 has rapidly decreased.

CONCLUSION

ILD shows a rising incidence in BRICS. with the trends varying based on age and other environmental factors. BRICS should strengthen specific public health approaches and policies for different stages and populations.

The Cancer Incidence and Trends From 2011 to 2018 in Ma'anshan, China: A Registry-Based Observational Study

BACKGROUND

The cancer burden in China has been increasing over the decades. However, the cancer incidence remains unknown in Ma'anshan, which is one of the central cities in the Yangtze River Delta in Eastern China. The study was designed to describe the cancer incidence and trends in Ma'anshan from 2011 to 2018, providing information about cancer etiology that is useful for prevention programs.

METHODS

The cancer incidence rate and age-standardized incidence rate (ASIR) were calculated using the cancer registry data in Ma'anshan during 2011-2018. The average annual percentage change (AAPC) of the ASIR was analyzed by the Joinpoint regression analysis. Age, period, and cohort effects on cancer incidence were estimated through the age-period-cohort model.

RESULTS

There were 13,508 newly diagnosed cancer cases in males and 9558 in females in Ma'anshan during 2011-2018. The ASIR maintained a steady trend in both males and females. Age effects showed that cancer risk increased with age in both genders; no visible period effects were detected during this study period. Cohort effects changed slowly until the end of the 1950s, then started decreasing in males while increasing in females after 1960. Lung, gastric, female breast, colorectal, cervical, esophageal, liver, thyroid, lymphoma, and pancreatic cancer were the most common cancers in Ma'anshan during the study period. The ASIR of gastric cancer (AAPC: -3.72%), esophageal cancer (AAPC: -8.30%), and liver cancer (AAPC: -5.55%) declined, while that of female breast cancer (AAPC: 3.91%), colorectal cancer (AAPC: 3.23%), and thyroid cancer (AAPC: 22.38%) rose.

CONCLUSION

During 2011-2018, the cancer incidence in Ma'anshan was lower than that in China, nation-wide. The incidence of upper gastrointestinal cancer decreased gradually while female breast, colorectal, and thyroid cancers showed an upward trend, consistent with the changes in the cancer spectrum in China. Further studies should be designed to discover the underlying causes of these findings.

Growth hormone reduces aneuploidy and improves oocytes quality by JAK2-MAPK3/1 pathway in aged mice

BACKGROUND

The global delay in women's reproductive age has raised concerns about age-related infertility. The decline in oocyte quality is a limiting factor of female fertility, yet there are currently no strategies to preserve oocyte quality in aged women. Here, we investigated the effects of growth hormone (GH) supplementation on aneuploidy of aged oocytes.

METHODS

For the in vivo experiments, the aged mice (8-month-old) were intraperitoneally injected with GH daily for 8 weeks. For the in vitro experiments, germinal vesicle oocytes from aged mice were treated with GH during oocyte maturation. The impacts of GH on ovarian reserve before superovulation was evaluated. Oocytes were retrieved to assess oocyte quality, aneuploidy and developmental potential characteristics. Quantitative proteomics analysis was applied to investigate the potential targets of GH in aged oocytes.

RESULTS

In this study, we demonstrated that GH supplementation in vivo not only alleviated the decline in oocyte number caused by aging, but also improved the quality and developmental potential of aged oocytes. Strikingly, we discovered that GH supplementation reduced aneuploidy in aged oocytes. Mechanically, in addition to improving mitochondrial function, our proteomic analysis indicated that the MAPK3/1 pathway may be involved in the reduction in aneuploidy of aged oocytes, as confirmed both in vivo and in vitro. In addition, JAK2 may also act as a mediator in how GH regulates MAPK3/1.

CONCLUSIONS

In conclusion, our research reveals that GH supplementation protects oocytes against aging-related aneuploidy and enhances the quality of aged oocytes, which has clinical significance for aged women undergoing assisted reproduction technology.

Efficacy and safety of Yi Shen Fang granules in elderly people with MCI: study protocol for a multicentre, randomized, double-blind, parallel-group, controlled trial

BACKGROUND

Mild cognitive impairment (MCI) is a transitional state between normal ageing and dementia. Most MCI patients will progress to dementia within 5 years; therefore, early intervention for MCI is important for delaying the occurrence and progression of dementia. Yi Shen Fang (YSF) granules are a promising traditional Chinese medicine (TCM) treatment that shows great neuroprotective potential against cognitive impairment, as evidenced in clinical and basic studies. This trial aims to systematically evaluate the efficacy and safety of YSF granules in elderly people with MCI.

METHODS

This study is a multicentre, randomized, double-blind, parallel-group, controlled trial. Based on the results of previous clinical trials, 280 elderly patients with MCI will be randomly divided into a treatment group (n = 140) and control group (n = 140). The study will last 33 weeks, including 1 week of screening, 8 weeks of intervention, and 24 weeks of follow-up. The primary outcomes will be the changes in Montreal Cognitive Assessment (MoCA) and Memory and Executive Screening (MES) scores before and after the intervention. The secondary outcome measures will be homocysteine (HCY) levels, Functional Assessment Questionnaire (FAQ) scores and event-related potential (ERP) detection in typical cases. The TCM symptom scale is a combined measure of syndrome differentiation and treatment. During this study, the classifications and characteristics of adverse events, the times of occurrence and disappearance, the measures of treatment, their impact on the primary disease, and outcomes will be reported truthfully.

DISCUSSION

This study will provide valuable clinical evidence that YSF can help to improve the cognitive function of elderly people with MCI, and the results will be disseminated via conferences and publications.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2000036807. Registered on August 25, 2020.

Association between air quality satisfaction, family relationships, and depression symptoms among middle-aged and elderly chinese people: the mediation role of perceived health status

BACKGROUND

Population aging has led to depression becoming a serious public health problem both in China and worldwide. Marital relationships, relationships with their children, and air pollution might play an important role in the process of depressive disorders. In this study, we aimed to reveal the mechanism of the effects of these factors on depression.

METHODS

Participants were recruited from The China Health and Retirement Longitudinal Study (CHARLS) (wave 4) from July 2018 to March 2019. Depression symptoms were evaluated using the 10-item Center for Epidemiologic Studies depression scale (CESD-10). Marital relationships, relationships with their children, air quality satisfaction, and perceived health status were analyzed using Likert 5-point evaluation methods. Structural equation modeling-path (SEM) models were used to explore these variables' mediation effects on depression symptoms.

RESULTS

Marital relationships, relationships with their children, air quality satisfaction, perceived health status, and depression symptoms were significantly associated with each other (P < 0.001). Mediation analysis showed that family relationships (standardized beta = -0.28 [-0.31, -0.26]) and quality satisfaction (standardized beta = -0.03 [-0.05, -0.01]) had negative effects on depression symptoms. The total indirect effects of family relationships and air quality satisfaction on depression symptoms were -0.06 (95% confidence interval (CI) = [-0.07, -0.05]) and -0.016 (95% CI = [-0.02, -0.01]), respectively.

CONCLUSION

Family relationships, air quality satisfaction, and perceived health status influenced depression symptoms. The effects of family relationships and air quality satisfaction on depression symptoms were significantly mediated by perceived health status. Therefore, perceived health status aspects should be considered when conducting targeted intervention toward depression symptoms among middle-aged and elderly adults.

A conversational analysis of aging in China from a cross-section of the labour market: a corpus-based study

Modern society is undergoing rapid technological growth and urbanisation. Despite the positive changes, there are still vulnerable categories of the population that cannot adapt so quickly to the new realities. The ageing process in the developed countries of Europe, America and Southeast Asia raises the issue of further labour market development. In this regard, it is vital to understand the linguistic picture of a quickly ageing labour market, such as China. Drawing on Conversation Analysis, this study aims to investigate the impact of the ageing process on the labour market and identify age-related trends in communication, behaviour and attitude. The focus is on the socio-economic context. The most important finding is that in most contexts, the language behaviour of ageing labour market participants leaned on three underpinning factors: age, social status and exposure to emotional pressure. Older adults in the Chinese labour market value their informal status, accept social hierarchy, follow strict etiquette rules, tend to self-victimise, and complain about feeling vulnerable. The present findings can help social workers in China improve care for ageing adults and allow other researchers to investigate older people's participation in the labour market.

Natural population cohort study on long-lived adults: West China longevity and ageing procedure (WCLAP)

PURPOSE

The West China longevity and ageing procedure (WCLAP) cohort study aims to provide guidance for older adults in western China with the aim of improving quality of life, reducing the burden of family care, summarising the characteristics of longevity lifestyles, building a Chinese-longevity-population biobank and exploring the mechanisms underlying population ageing.

PARTICIPANTS

Since the establishment of the WCLAP research baseline in 2018, a population of 1537 adults aged 80 years and above, living in the community, have been enrolled in the programme as research participants. Of these, 231 are aged 100 years and above. Participants are followed up every year.

FINDING TO DATA

WCLAP data are collected in five hospital research subcentres strategically located adjacent to the national 'Longevity Townships' of Chengdu Ziyang, Leshan, Yibin and Pengshan. Data collection included a comprehensive assessment of the participant's health (including physical, psychological, social and common chronic disease assessments), instrumental tests (body composition and muscle percentage) and the collection of biomedical-biobank samples (include blood, urine, faeces, hair and urine).

FUTURE PLANS

Through the annual cohort follow-up, survival-related information is collected at a group level. Analysis of biological samples facilitates biological characterisation at the microscopic level through proteomics, metabolomics, genomics and other techniques. Baseline data, group-level follow-up data and microbiological examination data are integrated together to provide an evaluation tool, exploring sarcopenia, disability, dementia, caregiver burden, ageing biomarkers and other influencing factors.

TRIAL REGISTRATION NUMBERS

2018-463; ChiCTR1900020754.

Awareness of initiative practice for health in the Chinese population: A questionnaire survey based on a network platform

BACKGROUND

In 2016, the Chinese government issued the Healthy China 2030 plan, which also produced the initiative practice for health (IPFH) concept. However, people’s knowledge and awareness of the IPFH are unclear.

AIM

To investigate awareness of IPFH in the Chinese population and explore the relevant influential factors.

METHODS

An internet-based self-designed questionnaire survey was used to collect respondents’ demographic characteristics and awareness of health and the IPFH from March 26 to April 18, 2020. IPFH consciousness was assessed by the scores for different related questions. The Student’s t test, the Chi-square test, and multiple logistic regression analysis were performed to analyze the differences and influencing factors.

RESULTS

A total of 2678 valid questionnaires were collected. Of the respondents, 973 (36.3%) had heard of the IPFH concept. In addition, 89.5% of participants agreed with the view that the IPFH is beneficial to improving quality of life, and over half thought that a regular schedule, a reasonable diet, tobacco and alcohol control, a cheerful mood, specific life goals and plans, taking the initiative to accept health-related education and implement health knowledge, good interpersonal relationships, and regular physical examinations were closely related to the IPFH. The majority of respondents paid attention to their health and usually obtained health-related knowledge via social media and were also willing to promote the IPFH. Most of the participants underestimated the role of hospitals, family doctors, and health managers in promoting the IPFH. Age, monthly income, and medical-related work experience were the influencing factors for IPFH awareness.

CONCLUSION

The Chinese population has limited knowledge of the IPFH. People with strong IPFH awareness are older, earn more, and have medical-related work experience.

A Multilevel Physical Activity Intervention Among Chinese Rural Older Adults (Stay Active While Aging): A Study Protocol for a Clustered Randomized Controlled Trial

Background

Although a large number of studies have confirmed the benefits of physical activity (PA) in preventing age-related diseases and disabilities, a growing number of older people spent more time in sedentary behavior as opposed to PA. To reverse the alarming trend, numerous studies have corroborated the effectiveness of PA interventions in improving PA among older adults. However, such research is scarce in rural China, where a majority of older adults do not meet the PA recommendation. The Stay Active While Aging (SAWA) aimed to conduct an intervention to improve the PA level among older adults in rural China.

Methods

The SAWA is designed as a single-blind, clustered randomized controlled trial carried out in rural Sichuan, China with an 8-week intervention and a 24-month follow-up. The intervention group will receive a multilevel intervention (individual, interpersonal, and community levels), while the control group will not. The primary outcome is the PA level. Secondary outcome measures include sedentary behavior level, self-efficacy, self-regulation, cognitive function, night-time sleep quality, and anthropometry. The difference-in-differences (DID) will be performed to investigate the between-group differences, adjusted for baseline data and covariates.

Discussion

The SAWA trial will provide a multilevel intervention based on the socio-ecologic model among older adults in rural China. We target the PA level and health status changes while also focus on the maintenance of such intervention during 24 months. If the SAWA produces positive results, it will be possible to recommend similar strategies to be implemented in other Chinese older adults and beyond.

Trial registration

ChiCTR2100045653 (https://www.chictr.org.cn/index.aspx).

Trends in depression incidence in China, 1990-2019

BACKGROUND

Depression is one of the most widespread health burdens for the general population in China. This study aims to assess the long-term trends of depression incidence in China between 1990 and 2019.

METHODS

The incidence data were drawn from the Global Burden of Disease Study 2019, and an age-period-cohort model was used in the analysis.

RESULTS

The net drift was -0.66% (95% CI: -0.79% to -0.53%) per year for both genders. For males, the local drift was lower than 0 (P<0.05) in those aged 10-54 years, and higher than 0 (P<0.05) in those aged 60-69 years. For females, the local drift was lower than 0 (P<0.05) in those aged 10-49 years and higher than 0 (P<0.05) in those aged 55-84 years. Females had a higher risk of depression incidence than males. Compared with the 1990-1994 period, the relative risk (RR) of depression incidence in 2015-2019 decreased by 12.2% in males and 12.3% in females, and compared to the 1903-1907 birth cohort, the cohort RRs in the 2008-2012 birth cohort decreased by 42.1% in males and 34.5% in females. Period and cohort RRs all showed an increased tendency in recent periods and birth cohorts.

LIMITATIONS

These data are macrolevel estimates at the national level, may have ecological fallacies.

CONCLUSIONS

Although the age-standard incidence of depression has declined in China as a whole in the last three decades, the incidence of depression among older individuals has increased. More efforts are needed to promote the mental health of elderly individuals in China.

Nutritional Risk, Health Outcomes, and Hospital Costs Among Chinese Immobile Older Inpatients: A National Study

Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions.

Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result.

Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of “at-risk” patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031–1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491–2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498–2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6–23.6), score of 4 (32.4, 95% CI: 24–41.4), and scores of ≥ 5 (36.8, 95% CI 28.3–45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6–27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8–43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3–57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system.

Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs.

Sex, Sleep Duration, and the Association of Cognition: Findings from the China Health and Retirement Longitudinal Study

BACKGROUND

We aimed to examine the association between sleep duration and cognitive impairment among elderly Chinese people.

METHODS

generalized linear modeling was used to analyze the baseline data for adults aged 65 years and over (n = 4785) selected from the 2011 China Health and Retirement Longitudinal Study (CHARLS). The two aspects of cognitive impairment assessed in the study were mental status and memory. Sex-stratified logistic regression models were conducted to identify the effect of sleep duration in the different gender groups.

RESULTS

of all the participants, 49.8% were females and 32.5% aged 75 years and over. Of the participants, 59.7% had short sleep duration (<7 h/day), and 9.0% of them had long sleep duration (>8 h/day). Compared to normal sleep duration, long sleep duration was associated with lower mental status scores (β = -0.43, p = 0.001) and lower memory scores (β = -0.26, p = 0.006). Long sleep duration was associated with lower mental status in both men (β = -0.37, p = 0.033) and women (β = -0.46, p = 0.025), however, only in men was long sleep duration found to be associated with low memory scores (β = -0.26, p = 0.047).

CONCLUSIONS

Our study showed that long sleep duration was significantly associated with poorer mental status and memory scores in elderly Chinese people. Paying greater attention to the effects of sleep patterns on the risk of cognitive decline may yield practical implications for dementia prevention and health promotion, especially among older women with lower educational attainment, living in rural areas, and those who have long sleep duration.

Association between visceral adipose index and risk of hypertension in a middle-aged and elderly Chinese population

BACKGROUND AND AIMS

Visceral adipose index (VAI) had been widely used to predict the risks of several diseases. However, few studies have clarified the association between VAI and the risk of hypertension in Chinese population. Thus, we investigate the association between VAI and the increased risk of hypertension in a nationwide cohort of middle-aged and elderly adults in China.

METHODS AND RESULTS

Data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2015. A total of 5200 Chinese participants aged 45 years and older were included. Multivariable Cox regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of hypertension, with the lowest quartile of VAI score group as the reference. During the 4-years follow-up, 979 cases of hypertension were recorded. Compared with those in the lowest VAI score group, the participants with the highest quartile of VAI score were at a higher risk level of hypertension (HR: 1.454; 95% CI 1.204 to 1.755), especially subjects living in the urban area (2.142, 1.522 to 3.014). Furthermore, VAI can improve the ability of both BMI and WC in predicting the risk of hypertension by 12.72% (95% CI: 5.78%-19.67%) and 10.12% (95% CI: 3.17%-17.07%), respectively.

CONCLUSION

In summary, VAI was positively associated with an increased risk of hypertension among a middle-aged and elderly Chinese population; VAI score can improve the ability of BMI and WC in predicting risk of hypertension.

Taller adult height is associated with better performance of cognitive trajectories in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study

AIM

The association between adult height and follow-up cognition requires an update in China. We aimed to examine the association between baseline height and follow-up cognitive trajectories in Chinese subjects from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

A total of 6508 adults aged 45 years or older from the CHARLS were included for analysis. Latent class growth modeling was used to determine cognitive trajectories of 2011, 2013 and 2015. Multivariable linear regression and logistic regression models were used to examine the association between baseline adult height and cognitive performance and trajectories, respectively.

RESULTS

At baseline, an increment of 1 SD (8.3 cm) of height was associated with a higher global cognitive score (β = 0.492, 95% CI, 0.348-0.636), verbal episodic memory (β = 0.155, 95% CI, 0.086-0.224) and mental status (β = 0.337, 95% CI, 0.225-0.449). These associations were still observed even when stratified by sex. Prospectively, for females, the third quartile of height level (i.e., 155 to 158 cm) was associated with a better global cognitive function trajectory (OR = 1.627, P = 0.001, P for trend = 0.009) and mental status trajectory (OR = 1.456, P = 0.012, P for trend = 0.047); and the tallest height level (i.e., 159 cm or taller) was related to a better verbal episodic memory trajectory (OR = 1.574, P = 0.017). For males, no associations were observed.

CONCLUSION

Increased stature might be associated with better cognitive trajectories for subjects in China. Geriatr Gerontol Int 2021; 21: 732-740.

A Novel Management Platform Based on Personalized Home Care Pathways for Medicine Management and Rehabilitation of Persons With Parkinson's Disease-Requirements and Implementation Plan of the Care-PD Program

As the percentage of the aging population increases, the incidence of Parkinson's disease (PD) in China is increasing year by year. PD is both a public health and social problem facing the government and society as a whole. Persons with PD need reasonable medication management and rehabilitation strategies after a clear diagnosis. A proper home care plan can effectively slow the progression of PD. However, people with PD lack an effective way to manage their illnesses and cannot achieve the recommended clinical path in a family environment. Medication management, condition monitoring, and rehabilitation training are important components of the home care plan for PD. Persons with PD require strategies that delay the development of the disease and to adhere to treatment, which would contribute to improving their quality of life. Thus, we developed a small program called Care-PD to build a medicine management and service platform for PD. The development of Care-PD is a multi-dimensional model designed for PD, which is funded by the National Key R&D Program of China (No. 2018YFC1314700), and includes services such as medication management, symptom monitoring, professional counseling, home life, and community communication. Care-PD can become a key technology that increases the compliance of persons with PD with home care plans and improve measures to control the disease. In this article, we describe the medication management and services for PD based on the Care-PD program and its structure. The small program will improve the adverse conditions faced by persons with PD by combining the latest technology and clinical approaches. Meanwhile, we describe a verification strategy to evaluate the effectiveness of the Care-PD program as a comprehensive management strategy for PD.

Trends in Incidence of Urinary Tract Infection in Mainland China from 1990 to 2019

Purpose

Urinary tract infection (UTI) is the second-most-common type of infection in China. This study aimed to determine the long-term trends in the incidence of UTI in Mainland China between 1990 and 2019.

Materials and Methods

Data were extracted from the Global Burden of Disease Study 2019 and were analyzed with the age–period–cohort framework.

Results

The net drift in the incidence of UTI was –0.37% (95% CI: –0.40%, –0.35%) in males and –0.25% (95% CI: –0.29%, –0.20%) in females. For males, the local drift was lower than 0 (P<0.05) among those younger than 90 years. For females, the local drift was lower than 0 (P<0.05) among those younger than 60 years and higher than 0 (P<0.05) in those aged 65–79 years. In the same birth cohort, the incidence of UTI was higher in females than in males in all age groups (P<0.05). The period relative risk (RR) showed a decreasing pattern after 2005 in both sexes. The cohort RR showed a downward trend of the birth cohort after 1905 for males and 1960 for females.

Conclusion

The incidence has increased significantly among older females over the past 30 years. It is necessary to develop a comprehensive intervention plan for reproductive health services covering females and males of all ages.

Association of the Time to First Cigarette and the Prevalence of Chronic Respiratory Diseases in Chinese Elderly Population

BACKGROUND

Increasing number of studies has suggested the time to first cigarette after waking (TTFC) have significant positive effect on respiratory diseases. However, few of them are focused on Chinese population. This study aims to estimate the impact of TTFC on the prevalence of chronic respiratory diseases (CRD) in Chinese elderly and explore the association in different sub-populations.

METHODS

Cross-sectional data of demographic characteristics, living environment, smoking-related variables, and CRD were drawn from the Chinese Longitudinal Healthy Longevity Survey in 2018. Multivariate stepwise logistic regression analyses were conducted to examine the association of the TTFC with the prevalence of CRD.

RESULTS

This study includes 13208 subjects aged 52 years and older, with a mean age of 85.3 years. Of them, 3779 participants are ex- or current smokers (44.9% had the TTFC ≤30 minutes, 55.1% >30 minutes) and 1503 have suffered from CRD. Compared with non-smokers, participants with TTFC ≤30 minutes seemed to have higher prevalence of CRD (OR 1.97; 95% CI, 1.65-2.35) than those with TTFC >30 minutes (OR 1.70; 95% CI, 1.44-2.00), although the difference was statistically insignificant (P_interaction=0.12). Compared with TTFC >30 minutes, TTFC ≤30 minutes could drive a higher prevalence of CRD among female participants, those aged 90 years and older, urban residents, and those ex-smokers (P_interaction<0.05).

CONCLUSIONS

Shorter TTFC relates to higher prevalences of CRD in Chinese older females, those aged 90 years and older, urban residents, and ex-smokers. Delaying TTFC might particially reduce its detrimental impact on respiratory disease in these specific subpopulations.

Knowledge, Attitudes, and Stigma Related to Dementia Among Illiterate and Literate Older Adults in Shanghai

Background

China has the largest population of patients with dementia worldwide, no assessment of illiterate old population’s dementia knowledge, attitudes, stigma have been conducted so far in China.

Aim

This study focused on the impact of education on knowledge, attitudes, and stigma related to dementia.

Methods

The community-based sample used in this study was recruited using multi-stage random sampling from residents aged ≥60 years registered in Shanghai. We used the Geriatric Depression Scale (GDS-30) to identify depression, and the Ascertain Dementia 8 questionnaire (AD8) for evaluating participants’ cognitive impairment. Knowledge, Attitude, Belief, and Practice scale, Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) were used for measuring dementia knowledge, attitudes, stigma. We separated the population into illiterate and literate group, propensity score matching based on age, sex, depression, and cognitive impairment. We calculated the difference of knowledge, attitudes, and stigma related to dementia between illiterate and literate groups.

Results

Two thousand five hundred and eighteen participants completed the survey. After propensity score matching, 186 pairs of matched participants left. The overall correct rate of dementia knowledge was 70.34%. The illiterate group had a lower percentage of correct answers for each knowledge item. The item “Dementia is not a disease, it is forgetfulness due to aging” had the lowest accuracy rate in both groups (38.71% vs. 50.54%, p=0.022). Illiterate older adults were less accepting of dementia than literate older adults. The majority of participants did not agree that: “There is no need to visit a doctor when older people have memory loss, difficulty communicating, or finding words” (56.99% vs. 68.28%). Illiterate older adults had higher scores for the items assessing stigma toward dementia than literate older adults.

Conclusion

Dementia-related knowledge and attitudes among community-dwelling older adults in Shanghai may be related to literacy.

Trends in Mortality Rates for Alzheimer's Disease and Other Dementias Over 30 Years in China

OBJECTIVE

This study examines trends in the mortality of Alzheimer's disease and other dementias in China from 1990 to 2019.

METHODS

The data were drawn from the Global Burden of Disease Study 2019 (GBD 2019), and an age-period-cohort model was used for analysis.

RESULTS

The net drift was .152% (95% confidence interval [CI]: .069%, .235%) per year for men (P < .05) and .024% (95% CI: -.078%, .126%) per year for women. The local drift values were below 0 in both genders for people aged 45-54 years (P < .05), and above 0 for males aged 60-94 years and females aged 60-79 years (P < .05). In the same birth cohort, the risk of mortality of Alzheimer's disease and other dementias exponentially increases with age for both genders.

CONCLUSION

More rapid and effective efforts are needed to mitigate the substantial impact of Alzheimer's and other dementias on the health of China's elderly.

A research agenda for ageing in China in the 21st century (2nd edition): Focusing on basic and translational research, long-term care, policy and social networks

One of the key issues facing public healthcare is the global trend of an increasingly ageing society which continues to present policy makers and caregivers with formidable healthcare and socio-economic challenges. Ageing is the primary contributor to a broad spectrum of chronic disorders all associated with a lower quality of life in the elderly. In 2019, the Chinese population constituted 18 % of the world population, with 164.5 million Chinese citizens aged 65 and above (65+), and 26 million aged 80 or above (80+). China has become an ageing society, and as it continues to age it will continue to exacerbate the burden borne by current family and public healthcare systems. Major healthcare challenges involved with caring for the elderly in China include the management of chronic non-communicable diseases (CNCDs), physical frailty, neurodegenerative diseases, cardiovascular diseases, with emerging challenges such as providing sufficient dental care, combating the rising prevalence of sexually transmitted diseases among nursing home communities, providing support for increased incidences of immune diseases, and the growing necessity to provide palliative care for the elderly. At the governmental level, it is necessary to make long-term strategic plans to respond to the pressures of an ageing society, especially to establish a nationwide, affordable, annual health check system to facilitate early diagnosis and provide access to affordable treatments. China has begun work on several activities to address these issues including the recent completion of the of the Ten-year Health-Care Reform project, the implementation of the Healthy China 2030 Action Plan, and the opening of the National Clinical Research Center for Geriatric Disorders. There are also societal challenges, namely the shift from an extended family system in which the younger provide home care for their elderly family members, to the current trend in which young people are increasingly migrating towards major cities for work, increasing reliance on nursing homes to compensate, especially following the outcomes of the 'one child policy' and the 'empty-nest elderly' phenomenon. At the individual level, it is important to provide avenues for people to seek and improve their own knowledge of health and disease, to encourage them to seek medical check-ups to prevent/manage illness, and to find ways to promote modifiable health-related behaviors (social activity, exercise, healthy diets, reasonable diet supplements) to enable healthier, happier, longer, and more productive lives in the elderly. Finally, at the technological or treatment level, there is a focus on modern technologies to counteract the negative effects of ageing. Researchers are striving to produce drugs that can mimic the effects of 'exercising more, eating less', while other anti-ageing molecules from molecular gerontologists could help to improve 'healthspan' in the elderly. Machine learning, 'Big Data', and other novel technologies can also be used to monitor disease patterns at the population level and may be used to inform policy design in the future. Collectively, synergies across disciplines on policies, geriatric care, drug development, personal awareness, the use of big data, machine learning and personalized medicine will transform China into a country that enables the most for its elderly, maximizing and celebrating their longevity in the coming decades. This is the 2nd edition of the review paper (Fang EF et al., Ageing Re. Rev. 2015).

Study design and baseline characteristics of Shenzhen ageing-related disorder cohort in China

PURPOSE

The Shenzhen ageing-related disorder cohort was designed to detect the associations of lifestyle, environmental and genetic factors with major ageing-related disorders, especially neurological and mental disorders.

PARTICIPANTS

The cohort was a community-dwelling prospective study of 9411 elderly adults aged 60 to 92 years from 51 community health service centres in Luohu district of Shenzhen, China. The baseline data were collected between 2017 and 2018, including demographics and socioeconomics, lifestyles, medical history, family history of major non-communicable chronic disease, environmental exposures, clinical analysis of blood and urine, clinical imaging measurements, anthropometric measures and neurological function and mental health assessments. Blood and urinary samples were collected at baseline. All participants will be followed for physiological and psychological disorders and updated lifestyle and environmental exposures every 5 years.

FINDINGS TO DATE

The mean age of the participants was 67.73 years at baseline, and 42.74% were males. The prevalences of individuals with unhealthy conditions were as follows: overweight/obesity (54.38%), hypertension (58.24%), diabetes mellitus (22.30%), dyslipidaemia (75.69%), chronic bronchitis (1.45%), myocardial infarction (0.55%), coronary heart disease (5.69%), stroke (1.10%), cancer (2.18%), arthritis (5.04%), Alzheimer's disease (0.18%), Parkinson's disease (0.23%), brain injury (5.75%), cognitive impairment (5.39%) and depression status (3.28%). The mean scores for the Lawton-Brody Activities of Daily Living Scale and the Social Support Rate Scale were 14.15 and 39.54, respectively.

FUTURE PLANS

2000 new entrants from Luohu district will be recruited every year until 2028. The data collection is expected to be ended at the end of 2030. The data will be used to assess the causality of ageing-related disorders, especially neurological and mental disorders through integrating environmental, genetic and lifestyle factors. The data sets generated and/or analysed during the current study are not publicly available at this stage, but are available from the corresponding author on reasonable request.

Preparation for future care moderates the relationship between loneliness and depression among Chinese rural older adults: A cross-sectional study

Loneliness has been identified as a risk factor for depression, while preparation for future care (PFC) can be a protective factor. Little is known about their complex relationships in older adults in China. This study aimed to explore whether PFC moderated the association between loneliness and depression. A total of 481 older adults aged 60 years and above were recruited in rural Shandong, China. After excluding those whose data missing rates were over 15%, data were analyzed for a total of 436 participants. Loneliness, PFC, and depression were measured. Statistical analyses included descriptive analysis, and moderating effects analyses. Our findings showed that PFC and its related dimensions can moderate the relationship between loneliness and depression. When the level of PFC and its dimensions were higher, the effect of loneliness on depression was weaker. PFC should be taken into consideration when interventions are being developed to reduce depression in older adults.

Association of socioeconomic factors and prevalence of hypertension with sleep disorder among the elderly in rural southwest China

OBJECTIVES

This study examines the distribution of sleep disorder prevalence across socioeconomic status (SES) and investigates the relationship between sleep disorders and hypertension among southwest China's rural older adult population.

METHODS

A cross-sectional survey was conducted in rural Yunnan Province, China from 2017 to 2018, consisting of 4833 consenting participants aged ≥60 years. Each participant completed a structured interview and had their blood pressure measured. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression was used to model variations in prevalence of sleep disorders and hypertension.

RESULTS

In the study population, the prevalence rates of sleep disorders and hypertension were 46.5% and 50.3%, respectively. Women had higher prevalence of both chronic illnesses (53.4% vs. 38.7%, 53.1% vs. 47.6%, P < 0.01). After adjusting for age, sex, and residential status, older adults of minority ethnicity had a higher prevalence of sleep disorders than the Han ethnic majority (P < 0.01). Attainment of higher levels of education and lower annual household income were also associated with a greater risk of sleep disorders (P < 0.01). Further, logistic regression analysis indicated that older adults with sleep disorders had a greater risk of being hypertensive (P < 0.01).

CONCLUSIONS

Sleep disorders are highly prevalent in rural southwest China. Future interventions to improve sleep quality would benefit from tailoring to address individual SES. Improving sleep quality profoundly reduces prevalence of hypertension.

Laparoscopic vs. open pancreaticoduodenectomy: a comparative study in elderly people

The purpose of the study is to evaluate whether laparoscopic pancreatoduodenectomy (LPD) is safe and feasible for elderly patients. From December 2015 to January 2019, 142 LPD surgeries and 93 OPD surgeries were performed by the same surgeon in the third affiliated hospital of Soochow University. After applying the inclusion and exclusion criteria, we retrospectively collected the date of three defined groups: LPD aged < 70 years (group I, 84 patients), LPD aged ≥ 70 years (group II, 56 patients) and OPD aged ≥ 70 years (group III, 28 patients). Baseline characteristics and short-term surgical outcomes of group I and group II, group II and group III were compared. Totally, 168 patients were included in this study; 100 cases were men; 68 cases were women; mean age was 67.9 ± 9.5 years. LPD does not perform as well in elderly as it does in non-elderly patients in terms of intraoperative blood loss (300.0 (200.0-500.0) ml vs. 200.0 (100.0-300.0) ml, p = 0.003), proportion of intraoperative transfusion (17.9% vs. 6.0%, p = 0.026) and time to oral intake (5.0 (4.0-7.0) day vs. 5.0 (3.0-6.0) day, p = 0.036). Operative time, conversion rate, postoperative stay, and proportion of reoperation, Clavien-Dindo classification, 30-day readmission and 90-day mortality were similar in two groups. In elderly patients, when compared with OPD, LPD had the advantage of shorter time to start oral intake (5.0 (4.0-7.0) day vs. 7.0 (5.0-11.3) day, p = 0.005) but the disadvantage of longer operative time (380.0 (306.3-447.5) min vs. 292.5 (255.0-342.5) min, p < 0.001) and higher hospitalization cost (12447.3 (10,189.7-15,340.0) euros vs. 7251.9 (8994.0-11,717.4) euros, p < 0.001). There was no difference between the two groups in terms of postoperative stay, and proportion of reoperation, Clavien-Dindo classification, 30-day readmission and 90-day mortality. LPD is safe and feasible for elderly people, but we need to consider its high cost and long operative time over OPD.